Impact of Acute Confusional State in Patients With COVID-19 and a Predictive Score.

Autor:	Gogia B; Neurology/Vascular Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA., Pujara D; Neurology, Case Western Reserve University, Cleveland, USA., Thottempudi N; Neurology, University of Texas Medical Branch at Galveston, Galveston, USA., Ghanayem T; Neurology, Vanderbilt University Medical Center, Nashville, USA., Ajam Y; Neurology, University of Texas Medical Branch at Galveston, Galveston, USA., Singh A; Neurology, Emory University School of Medicine, Atlanta, USA., Dabi A; Neurology, University of Texas Medical Branch at Galveston, Galveston, USA., Patil S; Internal Medicine, Northeast Internal Medical Associates, Fort Wayne, USA., Curtis K; Neurology, University of Texas Medical Branch at Galveston, Galveston, USA., Fang X; Neurology, University of Texas Medical Branch at Galveston, Galveston, USA., Patel K; Neurology, University of Texas Medical Branch at Galveston, Galveston, USA., Bhardwaj A; Neurology, University of Texas Medical Branch at Galveston, Galveston, USA., Rai P; Neurology, University of Texas Medical Branch at Galveston, Galveston, USA.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2021 Sep 28; Vol. 13 (9), pp. e18360. Date of Electronic Publication: 2021 Sep 28 (Print Publication: 2021).
DOI:	10.7759/cureus.18360
Abstrakt:	Background: Acute confusional state (ACS) in COVID-19 is shown to be associated with poor clinical outcomes. Methods: We assessed the impact of ACS - defined as a documented deterioration of mental status from baseline on the alertness and orientation to time, place, and person - on inpatient mortality and the need for intensive care unit (ICU) transfer in inpatient admissions with active COVID-19 infection in a single-center retrospective cohort of inpatient admissions from a designated COVID-19 tertiary care center using an electronic health record system. Furthermore, we developed and validated a neurological history and symptom-based predictive score of developing ACS. Results: Thirty seven out of 245 (15%) patients demonstrated ACS. Nineteen (51%) patients had multifactorial ACS, followed by 11 (30%) patients because of hypoxemia. ACS patients were significantly older (80 [70-85] years vs 50.5 [38-69] years, p < 0.001) and demonstrated more frequent history of dementia (43% vs 9%, p < 0.001) and epilepsy (16% vs 2%, p = 0.001). ACS patients observed significantly higher in-hospital mortality (45.9% vs 1.9%, aOR [adjusted odds ratio]: 15.7, 95% CI = 3.6-68.0, p < 0.001) and need for ICU transfer (64.9% vs 35.1%, aOR: 2.7, 95% CI = 1.2-6.1, p = 0.015). In patients who survived hospitalization, ACS was associated with longer hospital stay (6 [3.5-10.5] days vs 3 [2-7] day, p = 0.012) and numerically longer ICU stay (6 [4-10] days vs 3 [2-6] days, p = 0.078). A score to predict ACS demonstrated 75.68% sensitivity and 81.73% specificity at a cutoff of ≥3. Conclusion: A high prevalence of ACS was found in patients with COVID-19 in our study cohort. Patients with ACS demonstrated increased mortality and need for ICU care. An internally validated score to predict ACS demonstrated high sensitivity and specificity in our cohort. Competing Interests: The authors have declared that no competing interests exist. (Copyright © 2021, Gogia et al.)
Databáze:	MEDLINE
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